强化降脂在临床实践中的益处 推荐.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * 高剂量他汀类药物的安全性 – 肝功能 (AST和/或ALT 3 x ULN) JAMA. 2004;292:1307-1316; N Engl J Med 2004;350:1495-504. N Engl J Med 2005;352:1425-35.; JAMA. 2005;294:2437-2445 p=0.05 P0.001 P0.001 P0.001 0.36% 0.84% 1.10% 3.30% 0.18% 1.20% 0.16% 1.37% 0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50% A to Z PROVE-IT TNT IDEAL 标准剂量 高剂量 由于AE停止用药 N Engl J Med 2005;352:1425-35.; JAMA. 2005;294:2437-2445 P0.001 P0.004 7.2% 5.3% 14.0% 7.0% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% TNT IDEAL 高剂量 标准剂量 * * * * Atherosclerotic plaque has 2 main components: a soft, lipid-rich core and a hard, collagen-rich fibrous cap. In stable plaques, a thick fibrous cap may represent 70% of plaque volume. It stabilizes the plaque and prevents it from undergoing rupture. In contrast, unstable plaque has a thin fibrous cap and is at greater risk for rupture. In unstable plaque, the lipid-rich core may represent the majority of the plaque volume. The core is rich in extracellular lipids, which are formed by trapping blood-derived lipids, notably low-density lipoprotein, or by lipid-filled macrophages, known as foam cells. The plaque destabilizes due to inflammation by foam cells and other inflammatory mediators that make the plaque more vulnerable to rupture. This commonly occurs at the junction of the plaque and the less diseased vessel wall. As a result, the lipid core may be exposed to flowing blood leading to platelet-mediated thrombus formation. Falk reviewed the work of other investigators regarding the severity of stenosis and its association with the risk of MI. Results showed that 86% of MIs resulted from lesions that were 70% stenosed. Most experts prior to Falk thought that patients had heart attacks because of blockages that increased in size until they blocked the blood vessel and caused a heart attack.1 Based on the findings of Falk, we now know the primary cause of a heart attack is the rupture of unstable plaques that are 70% stenosed and are cl